2016 Election Fallout: The Looming Threat to People with Disabilities

  ·  Health Policy Hub   ·   Renee Markus Hodin

This is the first blog in a series to highlight the dangers of the repealing the Affordable Care Act. Multiple times a week, Community Catalyst will highlight a different constituency to draw attention to the benefits the ACA has afforded them and to outline what a loss of coverage would mean.

One of the great joys of my work over the last several years has been working with our advocacy partners from the disability community here in Massachusetts. It’s been through their eyes that I’ve come to deeply appreciate the essential nature of Medicaid and the Affordable Care Act to this population. That’s why I am deeply troubled that the results of one election could undermine critical aspects of the infrastructure that allows millions of people with disabilities to live independently and with dignity.

Just the Facts, Ma’am

So who is this population? According to a 2015 report from the Centers for Disease Control and Prevention, 53 million - or one out of every five - adults in the United States live with some kind of functional disability. This includes difficulty walking, seeing, hearing, remembering, doing errands, dressing or bathing. The report also revealed that Black and Hispanic adults were more likely to have a disability than White adults. Additionally, those with lower education and income levels, and those who are unemployed were also more likely to have a disability. And it’s because of this strong correlation between disability and poverty that we must look first at the major role Medicaid plays for the population.

Medicaid Matters… More Than Ever

Medicaid serves as a critical safety net for the 10 million+ kids and adults who qualify for the program on the basis of a disability. These people, who represent approximately 15 percent of all Medicaid beneficiaries, live with a wide range of physical, mental health and/or functional disabilities.

One of the reasons Medicaid is so critical to people with disabilities is its coverage of long-term services and supports (LTSS). Indeed, it is the only public or private program to cover LTSS.  And increasingly these services are being provided at home or in the community, rather than in institutions. Home and community based services allow people with disabilities to live independently in their homes and with dignity. It also allows them to maintain relationships and pursue meaningful work. This is what’s required by law and what’s desired by the vast majority of beneficiaries with disabilities.

As critical as Medicaid has always been to people with disabilities, the ACA provided new and faster pathways to eligibility. This has been particularly true in the 32 states that expanded Medicaid thereby allowing even greater numbers of people with disabilities to enroll in the program.

Innovation Nation in Peril?

With the creation of the Center for Medicare and Medicaid Innovation through the ACA, The Centers for Medicare and Medicaid Services (CMS) began investing in targeted experiments aimed at achieving the Triple Aim: better care for the individual, better care for the population and lower health care costs. For people with disabilities, this has meant the opportunity to have better coordinated care and improved access to LTSS that prevents unnecessary hospital and nursing home admissions. Examples of ACA-sponsored innovations that benefit people with disabilities include:

  • The Dual Eligible Demonstration Projects: Through this initiative, CMS is working with states to test two models to integrate primary, acute, behavioral health and long-term services and supports for Medicare-Medicaid enrollees and better align the financing of the Medicare and Medicaid programs.
  • Initiative to Reduce Hospital Readmissions Among Nursing Home Residents: This effort aims to improve the quality of care for people residing in nursing homes by using evidence-based clinical and educational interventions with the goal of reducing avoidable, and expensive, hospitalizations.
  • Community-Based Care Transitions Program: This program seeks to improve transitions of Medicare beneficiaries from the inpatient hospital setting to other care settings, to improve quality of care, reduce readmissions for high-risk beneficiaries and document measurable savings to the Medicare program.

The future of these and other innovations that improve care for people with disabilities and other vulnerable populations is most certainly in question.

Private Market Protections

Finally, for people with disabilities who have private insurance, several well-known (and popular!) ACA provisions are particularly important. These include the prohibitions against:

  • denying coverage for any reason, including pre-existing health conditions
  • lifetime monetary caps
  • charging consumers different rates based on their health status or claims history

Additionally, the ACA added two key nondiscrimination provisions that provide important protection for people with disabilities in the individual and small markets, namely:

The Bottom Line: Nothing About Us Without Us!

The results of the 2016 election create new threats to some of the most fundamental supports that the tens of millions of people with disabilities in our country rely on today. Together, we must work to protect Medicaid and Medicare and the continued investment in delivery and payment reforms that seek to improve the programs rather than tear them down. The rallying cry of the disability community, “Nothing About Us Without Us,” is particularly fitting as we enter the fight of our lives: for health care justice.